| Autor: |
Meola A; Department of Neurosurgery, University of Pittsburgh Medical Center;; Department of Neurosurgery, University of Pisa, Italy; and., Comert A; Department of Neurosurgery, University of Pittsburgh Medical Center;; Department of Anatomy, Ankara University School of Medicine, Ankara, Turkey., Yeh FC; Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania;, Sivakanthan S; Department of Neurosurgery, University of Pittsburgh Medical Center;, Fernandez-Miranda JC; Department of Neurosurgery, University of Pittsburgh Medical Center; |
| Jazyk: |
angličtina |
| Zdroj: |
Journal of neurosurgery [J Neurosurg] 2016 May; Vol. 124 (5), pp. 1406-12. Date of Electronic Publication: 2015 Oct 09. |
| DOI: |
10.3171/2015.4.JNS142741 |
| Abstrakt: |
OBJECT The dentatorubrothalamic tract (DRTT) is the major efferent cerebellar pathway arising from the dentate nucleus (DN) and decussating to the contralateral red nucleus (RN) and thalamus. Surprisingly, hemispheric cerebellar output influences bilateral limb movements. In animals, uncrossed projections from the DN to the ipsilateral RN and thalamus may explain this phenomenon. The aim of this study was to clarify the anatomy of the dentatorubrothalamic connections in humans. METHODS The authors applied advanced deterministic fiber tractography to a template of 488 subjects from the Human Connectome Project (Q1-Q3 release, WU-Minn HCP consortium) and validated the results with microsurgical dissection of cadaveric brains prepared according to Klingler's method. RESULTS The authors identified the "classic" decussating DRTT and a corresponding nondecussating path (the nondecussating DRTT, nd-DRTT). Within each of these 2 tracts some fibers stop at the level of the RN, forming the dentatorubro tract and the nondecussating dentatorubro tract. The left nd-DRTT encompasses 21.7% of the tracts and 24.9% of the volume of the left superior cerebellar peduncle, and the right nd-DRTT encompasses 20.2% of the tracts and 28.4% of the volume of the right superior cerebellar peduncle. CONCLUSIONS The connections of the DN with the RN and thalamus are bilateral, not ipsilateral only. This affords a potential anatomical substrate for bilateral limb motor effects originating in a single cerebellar hemisphere under physiological conditions, and for bilateral limb motor impairment in hemispheric cerebellar lesions such as ischemic stroke and hemorrhage, and after resection of hemispheric tumors and arteriovenous malformations. Furthermore, when a lesion is located on the course of the dentatorubrothalamic system, a careful preoperative tractographic analysis of the relationship of the DRTT, nd-DRTT, and the lesion should be performed in order to tailor the surgical approach properly and spare all bundles. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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